Steerable catheters and methods for using them

Abstract

An apparatus for treating tissue includes a flexible catheter including a proximal end, a distal end for introduction into a chamber of a heart, a transparent balloon carried by the distal end, an optical imaging assembly carried by the distal end for imaging tissue structures beyond the distal end through the balloon, and a needle deployable from the tubular member for penetrating the tissue structure to treat tissue. The apparatus may include a source of stems cells or other therapeutic and/or diagnostic agent coupled to the needle, a guide catheter advanceable over the needle for accessing a region beyond the tissue structure penetrated by the needle, and/or an energy probe deployable from the catheter for delivering electrical energy to tissue in the region beyond the tissue structure. The apparatus may be used to deliver stem cells into infracted tissue or for ablating heart tissue, e.g., from a trans-septal approach.

1 . An apparatus for treating a condition within a patient's heart, comprising 
 a flexible tubular member comprising a proximal end, a distal end having a size and length for introduction into a chamber of a heart from an access location;    a substantially transparent expandable member carried by the distal end of the tubular member, the expandable member being expandable from a collapsed condition to an expanded condition, the expandable member being sufficiently conformable such that, in the expanded condition, the expandable member is directable against a tissue structure, thereby substantially displacing fluid between the expandable member and the tissue structure;    an optical imaging assembly carried by the distal end of the tubular member and at least partially surrounded by the expandable member, the optical imaging assembly for imaging the tissue structure beyond the distal end through the expandable member; and    one or more needles deployable substantially axially from the tubular member through a lumen in the expandable member for penetrating the tissue structure to treat tissue.    
     
     
         2 . The apparatus of  claim 1 , further comprising a source of therapeutic agent coupled to the one or more needles, whereby the therapeutic agent may be delivered through the one or more needles into the tissue structure penetrated by the one or more needles.  
     
     
         3 . The apparatus of  claim 2 , wherein the source of therapeutic agent comprises a source of stem cells.  
     
     
         4 . The apparatus of  claim 1 , wherein the one or more needles have a length sufficient to penetrate through the tissue structure into a region beyond the tissue structure.  
     
     
         5 . The apparatus of  claim 4 , further comprising a guide catheter advanceable over the one or more needles for accessing the region beyond the tissue structure penetrated by the one or more needles.  
     
     
         6 . The apparatus of  claim 5 , wherein the guide catheter is advanceable over the tubular member after the expandable member is reduced to the collapsed condition.  
     
     
         7 . The apparatus of  claim 4 , wherein the distal end of the tubular member is tapered such the tubular member may be advanced over the needle into the region beyond the tissue structure after the expandable member is reduced to the collapsed condition.  
     
     
         8 . The apparatus of  claim 4 , further comprising an energy probe deployable through the tubular member for delivering electrical energy to tissue in the region beyond the tissue structure.  
     
     
         9 . The apparatus of  claim 8 , further comprising an energy source coupled to the probe for delivering sufficient energy to the probe to ablate the tissue in the region beyond the tissue structure.  
     
     
         10 . A method for delivering one or more therapeutic agents into tissue, comprising: 
 advancing a distal end of a tubular member through a body lumen into a body cavity;    expanding an expandable member on the distal end of the tubular member within the body cavity;    advancing the expanded expandable member against a wall of the body cavity;    imaging through the expandable member to observe tissue comprising a wall of the body cavity beyond the expandable member;    manipulating the tubular member to move the expandable member relative to the wall to identify a desired tissue structure; and    injecting one or more therapeutic agents from the tubular member into the desired tissue structure.    
     
     
         11 . The method of  claim 10 , wherein the expandable member is advanced against the desired tissue structure before injecting the one or more therapeutic agents.  
     
     
         12 . The method of  claim 10 , wherein the one or more therapeutic agents comprise stem cells.  
     
     
         13 . The method of  claim 10 , wherein the desired tissue structure comprises infarcted tissue.  
     
     
         14 . The method of  claim 10 , wherein the one or more therapeutic agents are injected into the desired tissue structure from a needle advanced from the tubular member into the desired tissue structure.  
     
     
         15 . A method for treating tissue within a body lumen, comprising: 
 advancing a tubular member from a body lumen into a first body cavity;    expanding an expandable member on the distal end of the tubular member within the first body cavity;    advancing the expanded expandable member against a wall of the body cavity;    imaging through the expandable member to observe tissue comprising a wall of the body cavity beyond the expandable member;    manipulating the tubular member to move the expandable member relative to the wall to identify a desired tissue structure;    creating a puncture through the desired tissue structure into a second body cavity; and    performing a procedure within the second body cavity via the puncture.    
     
     
         16 . The method of  claim 15 , wherein the step of performing a procedure, comprises: 
 collapsing the expandable member;    advancing the tubular member through the puncture into the second body cavity; and    expanding the expandable member in the second body cavity to image tissue surrounding the second body cavity;    manipulating the tubular member to identify a target tissue region surrounding the second body cavity; and    treating the target tissue region with a probe advanced through the tubular member.    
     
     
         17 . The method of  claim 16 , wherein the step of treating the target tissue region comprises: 
 advancing an energy probe from the tubular member into contact with the target tissue region; and    delivering energy to the target tissue region to ablate the target tissue region.    
     
     
         18 . The method of  claim 16 , wherein the puncture is created by advancing a needle from the tubular member through the desired tissue structure into the second body cavity.  
     
     
         19 . The method of  claim 18 , wherein the step of performing a procedure within the second body cavity comprises: 
 advancing a guide catheter over the needle into the second body cavity; and    introducing a probe into the second body cavity via the guide catheter.    
     
     
         20 . The method of  claim 19 , wherein the step of performing a procedure within the second body cavity further comprises delivering electrical energy from the probe to tissue within the second body cavity.